Claude Skills by dromlakhani

Evaluates central hypothyroidism (CH) patients for adrenal insufficiency (AI) prior to initiating levothyroxine (L‑T4) replacement. Triggers include consideration of L‑T4 start in central hypothyroidism needing thyroid replacement.

Recommends treating central hypothyroidism before performing GH stimulation testing because CH may impair accurate diagnosis of GHD. Use when preparing for GH stimulation testing; triggers include patient requiring GH stimulation test with possible CH.

This skill confirms central hypothyroidism when serum free T4 is below the laboratory reference range with low, normal, or mildly elevated TSH in the setting of pituitary disease. Use when assessing thyroid function in pituitary disease; triggers include pituitary disease with suspected thyroid dysfunction.

Recommend against using levotriiodothyronine (L-T3), thyroid extracts, or other thyroid hormone formulations for central hypothyroidism. Triggered when evaluating thyroid hormone replacement in central hypothyroidism (e.g., 'considering thyroid hormone replacement for central hypothyroidism' or 'central hypothyroidism requiring thyroid hormone replacement').

Individualizes desmopressin (DDAVP) therapeutic schedules for diabetes insipidus, educates patients on overdose risk, and recommends a weekly polyuria phase to assess medication wear‑off. Triggered when initiating DDAVP for diabetes insipidus (e.g., “Use when starting DDAVP for diabetes insipidus…” or “Triggers include: diabetes insipidus requiring desmopressin therapy”).

Manages post-pituitary surgery diabetes insipidus (DI) to assess recovery of posterior pituitary function. Triggers include managing DI after pituitary surgery requiring assessment of posterior function via DDAVP discontinuation trial.

Recommends that all diabetes insipidus patients wear an emergency bracelet or necklace to alert clinicians to their condition if incapacitated. Use when establishing care for a diabetes insipidus patient; triggers include diabetes insipidus diagnosis.

This skill guides the simultaneous measurement of serum and urine osmolarity to evaluate polyuria for central diabetes insipidus. It is triggered when a patient presents with polyuria exceeding 50 mL/kg/24 hours or 3.5 L/day in a 70‑kg individual.

Monitors fT4 levels and adjusts levothyroxine dose to maintain fT4 within the target range when central hypothyroidism patients require changes in estrogen therapy. Triggers include initiating, stopping, or adjusting estrogen therapy (oral or transdermal) in a patient with known central hypothyroidism.

This skill recommends against using growth hormone (GH) to enhance athletic performance, as the practice is illegal, lacks scientific or ethical justification, and has no substantiated efficacy. It is triggered when a patient requests GH for athletic performance enhancement or when considering GH replacement for athletic performance.

Recommends against biochemical testing for adult growth hormone deficiency when patients exhibit clear-cut features of GHD alongside three or more documented pituitary hormone deficits. Triggers when evaluating a patient with apparent GHD and multiple hormone deficits such as central hypothyroidism, adrenal insufficiency, and hypogonadism.

Uses BMI-specific cutoffs to interpret peak GH values during stimulation testing. Use when interpreting GH stimulation test results; triggers include GH stimulation test requiring BMI-adjusted interpretation.

Monitors euthyroid adults with growth hormone deficiency (GHD) who are initiating GH replacement therapy for the development of central hypothyroidism (CH). Initiates levothyroxine (L-T4) if free thyroxine (fT4) falls below the laboratory reference range; triggers include GHD patient starting GH replacement.

Calculates the initial growth hormone (GH) replacement dose based on patient age for adults with proven growth hormone deficiency (GHD). Triggers include initiating GH replacement in patients with proven GHD requiring GH replacement.

Recommends against administering growth hormone to elderly adults who have age-adjusted low IGF-1 levels and no history of pituitary or hypothalamic disease. Triggered when considering GH replacement in an elderly patient with low IGF-1 (e.g., 'elderly patient with low IGF-1 considering GH replacement').

Suggests discontinuing growth hormone (GH) replacement during pregnancy due to lack of clear evidence for efficacy or safety and placental GH production. Triggers include managing a pregnant patient on GH replacement.

Recommends GH stimulation testing for patients with suspected growth hormone deficiency (GHD). Triggers include evaluating a patient for suspected GHD when single GH measurements are not helpful.

Titrates GH replacement dose to keep IGF-1 below the upper limit of normal and reduces dose when side effects appear. Use when monitoring GH replacement therapy; triggers include patient on GH replacement needing dose adjustment.

Recommends against performing dynamic GnRH stimulation testing in the evaluation of hypogonadism, as it provides no additional diagnostic information beyond baseline gonadotropins and sex steroids. Consider this recommendation when evaluating hypogonadism and contemplating GnRH testing.

Suggests initial therapy for diabetes insipidus utilizes short-acting aqueous ADH, allowing safer use in the vast majority of cases where DI resolves spontaneously. Triggers include: new diabetes insipidus diagnosis requiring initial therapy, use when starting diabetes insipidus treatment.

Determines levothyroxine dosing for central hypothyroidism to achieve serum free T4 in the mid to upper half of the reference range. Triggers include confirmed central hypothyroidism requiring thyroid hormone replacement when initiating L‑4 therapy.

Manages suspected mild central hypothyroidism in patients with pituitary disease and low-normal free thyroxine (fT4). Initiates levothyroxine (L-T4) when suggestive symptoms are present or when serial fT4 shows a decrease of 20% or more.

Recommends against prescheduled desmopressin (DDAVP) dosing in the first week after pituitary surgery due to hyponatremia risk from transient diabetes insipidus resolution and syndrome of inappropriate antidiuretic hormone secretion occurring 7–10 days postoperatively. Use when managing a postoperative diabetes insipidus patient in the first week after surgery.

Suggests women on oral estrogen replacement receive higher GH doses compared to eugonadal females or males. Triggers when managing GH replacement in a woman on oral estrogen requiring GH therapy (e.g., "female on oral estrogen needing GH replacement").

Administers glucocorticoid coverage in patients with pituitary apoplexy to prevent adrenal crisis while awaiting definitive laboratory diagnosis. Triggers include managing a pituitary apoplexy patient needing glucocorticoid coverage until laboratory confirmation of pituitary function.

Recommends testing for acute pituitary insufficiency in all patients with pituitary apoplexy. Use when managing pituitary apoplexy patient; triggers include pituitary apoplexy diagnosis.

Monitors for diabetes insipidus development after glucocorticoid replacement in cured acromegaly patients; recommends adrenal insufficiency testing if diabetes insipidus improves without an adrenal insufficiency diagnosis. Triggered when managing a cured acromegaly patient receiving glucocorticoid replacement.

Recommend continuing glucocorticoid replacement until hypothalamic-pituitary-adrenal (HPA) axis recovery after surgical resection of ACTH-secreting pituitary tumors. Use when managing postoperative patients following ACTH-secreting tumor surgery to prevent adrenal insufficiency during HPA axis recovery.

Retest thyroid and GH axes after curative surgery for Cushing's disease before initiating hormone replacement. Use when managing postoperative Cushing's disease patient; triggers include postoperative Cushing's surgery patient needing hormone reassessment.

Diagnoses gonadotrope dysfunction in postmenopausal women by confirming absent high serum FSH and LH when not on hormone replacement therapy. Use when evaluating a postmenopausal woman for hypogonadism; triggers include postmenopausal woman with suspected hypogonadism.

Recommends that clinicians monitor pituitary axes in pituitary apoplexy patients treated with surgical decompression or conservative management because hypopituitarism may develop over time. Use when managing pituitary apoplexy patient; triggers include pituitary apoplexy patient needing longitudinal monitoring.

Recommends retesting all pituitary axes starting at 6 weeks after pituitary surgery and periodically to monitor development or resolution of pituitary deficiencies. Use when managing postoperative pituitary surgery patient; triggers include postoperative pituitary surgery patient needing longitudinal hormone monitoring.

Measures free T4 6–8 weeks after pituitary surgery in patients with intact preoperative thyroid function to detect central hypothyroidism. Triggers include postoperative patient needing thyroid function assessment and postoperative patient with intact preoperative thyroid function.

This skill guides perioperative levothyroxine management for adults with preoperative central hypothyroidism undergoing non-emergency surgery. Trigger phrases include "preoperative central hypothyroidism patient requiring non-emergency surgery" and "use when managing preoperative CH patient".

Recommends reassessing all pituitary axes in patients with macroprolactinoma and central hypogonadism who have had successful dopamine agonist treatment. Use when managing a macroprolactinoma patient after dopamine agonist treatment with normalized prolactin and tumor shrinkage.

Recommends against using serum TSH levels to guide levothyroxine dose adjustments in patients with central hypothyroidism. Triggers include evaluating a central hypothyroidism patient on levothyroxine who requires dose adjustment.

This skill recommends adding pegvisomant or cabergoline to ongoing somatostatin receptor ligand (SRL) therapy when a patient exhibits an inadequate biochemical response, defined as failure to achieve age‑normalized IGF‑1 or random GH <1 µg/L despite maximally tolerated SRL dose. Consider this step when IGF‑1 remains elevated or GH is not suppressed after an adequate SRL trial, indicating need for combination therapy.

Recommends annual GH and IGF-1 reassessment following medication withdrawal to assess the efficacy of radiation therapy in patients with acromegaly. Use during long-term follow-up after radiotherapy when evaluating biochemical control after a planned drug-free interval.

Recommends annual hormonal testing of patients following radiotherapy to monitor for hypopituitarism and other delayed radiation effects. Use in survivorship care after RT when patients have received pituitary or hypothalamic RT/SRT.

This skill advises against measuring GH or IGF-1 in pregnant patients with acromegaly because placental GH variant interferes with assay interpretation. Use when evaluating hormone testing in a pregnant acromegaly patient.

The guideline recommends against routine preoperative medical therapy (e.g., somatostatin receptor ligands) solely to improve postoperative biochemical control in acromegaly. Consider this when planning transsphenoidal surgery and evaluating whether to initiate medical pretreatment.

Recommends against using random GH levels to diagnose acromegaly because of pulsatile secretion. Use when a clinician considers ordering a random GH test to evaluate for acromegaly in a patient with suggestive features.

This skill advises against routine abdominal ultrasound to screen for gallstone disease in patients receiving somatostatin receptor ligands (SRLs) such as octreotide LAR or lanreotide autogel. Consider this recommendation when planning surveillance imaging for cholelithiasis in asymptomatic SRL-treated acromegaly patients.

Suggests screening for colon neoplasia with colonoscopy at the time of acromegaly diagnosis to establish baseline colorectal cancer risk. Trigger when a patient receives a new diagnosis of acromegaly (elevated IGF‑1 with lack of GH suppression after oral glucose tolerance test).

Recommends confirming acromegaly in patients with elevated or equivocal IGF-1 by demonstrating lack of GH suppression to <1 µg/L after an oral glucose load. Triggers include equivocal IGF-1 results requiring diagnostic certainty before proceeding to imaging.

This skill guides discontinuation of long-acting somatostatin receptor ligands (SRLs) and pegvisomant approximately two months before conception attempts in patients with acromegaly, substituting short-acting octreotide as needed for disease control. Trigger phrases include "preconception planning," "patient planning pregnancy," or "about to attempt conception."

Consider discontinuing pegvisomant when alanine aminotransferase (ALT) or aspartate aminotransferase (AST) exceeds three times the upper limit of normal (ULN) during routine monthly liver function testing. This trigger applies to patients receiving pegvisomant for acromegaly who demonstrate transaminase elevations >3× ULN on LFT monitoring.

Recommends applying standard acromegaly treatment approaches to normalize GH and IGF-1 in patients with pituitary gigantism. Use when evaluating a child or adolescent with excessive linear growth prior to epiphyseal closure, elevated IGF-1, and nonsuppressed GH after glucose load.

Recommends assessing for hypopituitarism and replacing hormone deficits in patients with acromegaly at diagnosis and during follow‑up. Triggered by confirmed elevated IGF‑1, post‑surgical or post‑radiation evaluation, or emergence of symptoms such as fatigue, cold intolerance, or loss of libido.

This skill suggests measuring serum IGF-1 in patients who lack typical acromegaly features but present with associated comorbidities such as sleep apnea, type 2 diabetes, debilitating arthritis, carpal tunnel syndrome, hyperhidrosis, or hypertension. It is triggered when a clinician encounters a patient with these conditions without classic signs of acromegaly.